Question:
We are searching for a continence advisor to help manage diarrhea post ileostomy reversal. Patient is a 77 yo male s/p ileostomy reversal, with multiple surgical complications requiring a 2month hospitalization and then discharged homes. Bathroom trips are frequent and we are looking for support to manage the frequency and duration of bowel movements. Any help is appreciated.
Answer:
Recovering from an ileostomy reversal can be challenging, especially when it comes to managing frequent and urgent bowel movements. A Continence Advisor or a NSWOC (Nurse Specialized in Wounds, Ostomy, and Continence) can provide expert guidance to help manage these concerns effectively.
How a Continence Advisor or NSWOC Can Help:
Dietary Guidance
- Adjusting your diet can significantly impact bowel function. A Continence Advisor or NSWOC can help identify foods that bulk up stool, slow bowel movements, or, conversely, those that might trigger diarrhea. (See detailed dietary recommendations below.)
Bowel Training
- Techniques such as setting regular bathroom times and gradually increasing the interval between them can help reduce urgency and frequency.
Medications
- Medications like loperamide (Imodium) or other bowel motility regulators may be recommended in collaboration with a doctor to help slow bowel movements.
Pelvic Floor Exercises
- Strengthening the pelvic floor muscles can improve bowel control. A Continence Advisor or NSWOC can teach exercises that may help.
To find a professional near you:
- To find a NSWOC close to you : https://membersnswoc.ca/find.phtml
- To find a Nurse Continence Advisor close to you : https://www.canadiancontinence.ca/locate-a-professional
Dietary Strategies to Slow Bowel Movements and Thicken Stool:
Proper dietary adjustments can be highly effective in regulating bowel movements after an ileostomy reversal. The goal is to consume foods that are gentle on the digestive system while avoiding those that irritate the bowel.
1. Foods That Help Thicken Stool – These foods are easy to digest and help form firmer stools:
✅ Bananas – Rich in pectin, which absorbs liquids and firms stool.
✅ Applesauce – A soluble fiber source that thickens stool, easier to digest than raw apples.
✅ White Rice – Low in fiber, helps absorb excess fluid.
✅ Peeled, Well-Cooked Potatoes – Starchy and low in fiber, bulks up stool.
✅ Oatmeal (Plain) – Contains soluble fiber that helps firm stool.
✅ White Bread/Toast – Absorbs excess liquid in the intestines.
✅ White Pasta – Easy to digest, helps thicken stool.
✅ Canned Peaches or Pears (Without Skin) – High in pectin, gentle on digestion.
2. Soluble Fiber-Rich Foods – Soluble fiber absorbs water and forms a gel-like substance, helping slow bowel movements.
✅ Cooked Carrots – A good source of soluble fiber.
✅ Pumpkin (Cooked) – Gentle on digestion, helps thicken stool.
✅ Psyllium (Metamucil) – A soluble fiber supplement that helps regulate bowel movements.
✅ Smooth Peanut Butter – Easy to digest, adds thickness to stool.
✅ Avocados – High in soluble fiber and healthy fats.
3. Foods to Avoid (Can Worsen Diarrhea or Increase Stool Frequency):
🚫 High-Fat Foods – Fried foods, fatty meats, creamy sauces.
🚫 Spicy Foods – Peppers, hot sauces, chili.
🚫 High-Fiber Foods (Initially) – Raw vegetables, whole grains, beans, legumes.
🚫 Caffeine – Coffee, tea, cola drinks.
🚫 Artificial Sweeteners – Sorbitol, mannitol (found in sugar-free products).
🚫 Dairy (If Lactose Intolerant) – Can cause bloating, cramping, and diarrhea.
4. Hydration:
- Drink plenty of clear fluids (water, broth, herbal teas).
- Oral Rehydration Solutions (ORS) help replace lost electrolytes due to frequent bowel movements.
5. Meal Timing & Digestion Tips:
- Eat small, frequent meals (5-6 times per day) instead of large meals.
- Chew food thoroughly to aid digestion and reduce irritation.
6. Probiotics:
- Probiotic-rich foods (yogurt, kefir, sauerkraut) may help restore gut balance.
- Probiotic supplements can help regulate stool consistency.
- Perianal Skin Care After an Ileostomy Reversal
Frequent bowel movements can cause irritation, redness, and skin breakdown around the anus. Here’s how to protect your skin:
1. Keep the Area Clean and Dry
- Use lukewarm water and a mild, fragrance-free soap or sensitive skin wipes.
- Avoid scrubbing; gently pat dry with a soft towel.
2. Protect the Skin
- Barrier creams with zinc oxide (e.g., Desitin, Calmoseptine) create a protective layer.
- Petroleum jelly or specialized skin barrier wipes can help reduce irritation.
3. Avoid Excessive Rubbing
- Use soft toilet paper or alcohol-free wipes.
- A peri-bottle (water squirt bottle) can be gentler than wiping.
4. Avoid Sitting for Long Periods
- Prolonged sitting increases moisture and friction—use a soft cushion if needed.
Final Thoughts
Navigating recovery after an ileostomy reversal can be overwhelming, but working with a NSWOC or Continence Advisor can provide personalized guidance to help manage symptoms effectively. Implementing dietary changes, bowel training, proper skin care, and hydration strategies can significantly improve comfort and overall well-being.
If you have further questions, don’t hesitate to reach out for professional support.
Answered by
Tom Chang, NSWOC, RN
